Basic Information
Provider Information
NPI: 1063175693
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCMULLEN
FirstName: BRITNEY
MiddleName: JANEE'
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 965 RIDGE LAKE BLVD STE 315
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381209401
CountryCode: US
TelephoneNumber:  
FaxNumber: 9012278591
Practice Location
Address1: 80 HUMPHREYS CENTER DR STE 210
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381202353
CountryCode: US
TelephoneNumber: 9017613900
FaxNumber: 9015782572
Other Information
ProviderEnumerationDate: 10/20/2021
LastUpdateDate: 02/24/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X29628TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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